Infertility Diagnosis

For pregnancy to take place, the male gamete and the female gamete fusion is essential. Approximately 15% of infertile couples are known to have unexplained infertility while 85% are identifiable. Factors such as the environment, obesity and smoking affect people´s fertility. The main causes are due to ovulatory dysfunction, male factor infertility and tubal disease. We understand sterility as the inability of a couple to achieve fertilization and the diagnosis of an infertile couple is carried out according to the parameters.

 

Female Infertility Diagnosis

A person is classified as infertile when they cannot get pregnant after one year of actively trying. A woman is fertile when her ovaries release healthy eggs. That is, the process where the egg passes through the fallopian tubes and joins the sperm and then, once the fertilized egg travels through the uterus and implants itself in the lining, it should occur normally. With infertility tests for women we seek to determine if any of the reproductive processes is being altered. In order to evaluate the main cause of infertility, it is necessary to evaluate the following medical aspects to generate a clinical history:

  • Previous pregnancies.
  • Abortions.
  • Pelvic pain.
  • Menstrual cycle´s regularity, duration and flow.
  • Family health history.
  • Any previously diagnosed illness or disease.
  • Anatomy of the reproductive system (uterus and fallopian tubes).
  • Ovarian functionality.

 

A Pap smear (also known as a Pap smear or cervical screening) and a blood test will be the main doctor´s basic requirements as a starting point; however, the specialist may also request:

● Laparoscopy

Minimally invasive surgery performed with an incision to introduce a camera, achieving internal visibility of the reproductive system. Laparoscopy, as a diagnostic and therapeutic method, is generally reserved for patients without an infertility identifiable cause. Direct visualization of the pelvic cavity and reproductive anatomy is the only method available for the specific diagnosis of tubal and peritoneal factors not diagnosable by other techniques and their immediate microsurgical resolution if found.

● Hormone analysis 

This type of test can detect and evaluate hormonal imbalances that may be causing problems. The most important hormones for reproduction are follicle-stimulating hormone (FSH) and testosterone (T), as well as luteinizing hormone (LH), estradiol, and prolactin.

Hysterosalpingography (HSG)

An x-ray exam to check the fallopian tubes and uterus condition to rule out abnormalities, using a dye that will contrast with the x-rays for more accurate detection. The purpose of this test is to define the uterine cavity´s size and shape and thus find abnormalities in development (unicornuate, bicornuate or septate uterus) or acquired (endometrial polyps, submucosal fibroids or synechiae) wich cause consequences in fertility. The second purpose is to determine the fallopian tubes permeability, being able to identify proximal or distal occlusions, demonstrate isthmic salpingitis nodosa, reveal anatomical details of the tubes and suggest the presence of fimbrial phimosis or peritubal adhesions when the contrast medium exits; either retarded or loculated, respectively.

● Hysteroscopy 

It is a procedure that allows visualizing the uterus with the help of a small camera. Hysteroscopy is the method for the uterine cavity evaluation and its abnormalities diagnosis. It is the most expensive and invasive method.

● Hydrosonography

A small ultrasound technique where a saline solution infusion is introduced into the vagina through a small tube. Irregularities in menstrual bleeding may be observed. The details that can be obtained through this investigation are more precise: they can visualize anatomical structures that cannot be located by hysterosalpingography.

● Ovulation test 

This test seeks to know the fertile days of the patient’s menstrual cycle. It is normally required with patients who are currently seeking pregnancy.With it, the hormone LH level in the urine is determined, which increases when ovulation occurs.

● Image Test

MRI is an imaging technique that uses a magnetic field and radio waves to develop images of the body´s internal organs. Through magnetic resonance imaging we can detect situations, identify injuries or rare abnormalities within the pelvis and uterus.

 

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Male infertility Diagnosis

Male fertility requires the testicles to make enough healthy sperm in order for the sperm to be ejaculated correctly into the vagina and travel to the egg. With male infertility tests we try to determine if any of these processes is being altered.

In order to know the infertility cause in any male patient, it is necessary to evaluate the following medical aspects:

  • General physical exam.
  • Family health history (hereditary diseases).
  • Any previously diagnosed illness or disease.
  • Semen analysis.
  • Functionality of the testicles.

 

For a more specific examination (in case of irregularities) the doctor may request one of the following studies:

Hormone analysis

A blood test can measure the hormones level or testosterone produced by the pituitary gland, hypothalamus, and testicles.

● Genetic analysis 

Analysis where the chromosomes level is checked to detect or rule out any complication and genetic and/or hereditary alteration.

● Testicular biopsy 

In some cases, the problem is an epididymis blockage or obstruction. A sample of testicular tissue is obtained, which makes it possible to identify whether sperm production is normal.

● Urinalysis (after ejaculation) 

This is a test finds out if the urine contains sperm, which would indicate that the semen is being transported to the bladder and not expelled from the penis as it should.

● Transrectal or scrotal ultrasound 

Transrectal ultrasound, also known as TRUS, is an imaging test of the prostate, seminal vesicles, and vas deferens.  It is used to analyze the obstructive azoospermia causes. Scrotal ultrasound shows the conditions of a man’s testicles and surrounding tissues to assess for any testicles, epididymis, and scrotum disorders.

● Semen analysis 

The doctor may request one or more semen samples. Semen is usually obtained by masturbating or stopping intercourse and ejaculating your semen into a clean container. A lab analyzes your semen sample. In some cases, urine can be tested for sperm presence.

● Chlamydia test

Chlamydia is a disease that can be easily cured with antibiotics. However, if it is not treated in a timely manner, it can lead to serious complications such as infertility.Your doctor may order this test to check for chlamydia bacteria.

 

 Treatments

  • The treatment will depend on many factors and to determine the most appropriate for each couple, the following must be taken into account:
  • What is causing the infertility? By attending the causes, we will find the most appropriate solution.
  • How long have you been infertile? The time factor is decisive, knowing if a patient has procreated before and is currently unable in order to help determine the right treatment.
  • Patient and couple´s age. Age is an important factor in finding the right treatment, women over 35 are more likely to be infertile.
  • Personal preferences. Not all treatments are tailored to the couple´s needs.

 

Treatments for women

  • Stimulate ovulation with fertility drugs. With the use of drugs you can stimulate and regulate ovulation, these are known as drugs to promote fertility. This treatment is the main one for women who are infertile due to ovulation disorder. The most common medicines are clomiphene citrate, gonadotropins, metformin, letrozole, bromocriptine.
  • Intrauterine insemination (IUI). Intrauterine insemination is an artificial insemination process, which is used to treat infertility.
  • This procedure involves introducing sperm directly into the uterus, allowing healthy sperm to get closer to the egg.
  • Intrauterine insemination can be coordinated with your normal cycle or with fertility drugs.
  • Surgery to restore fertility. Surgeries to reverse infertility are currently not widely used because other procedures have had a good success rate, including laparoscopic and hysteroscopic surgery that help correct problems in the uterine anatomy. Another surgical procedure of this type is tubal surgery, which helps correct problems with blocked or fluid-filled fallopian tubes.

 

Treatment for men

  • Change lifestyle. Many couples have been unable to have children due to poor sperm quality, these conditions can be reversed by changing lifestyle. You must have a healthy diet, practice sports, not consume tobacco and alcohol, among others.
  • Medications. With prescribed medications, certain hormonal conditions can be treated.
  • Surgery. Surgical intervention seeks to correct the vas deferens obstruction or recover the sperm stored in the testicles.
  • Assisted reproduction. These techniques seek to obtain sperm through ejaculation or through donors. Subsequently, the collected semen is introduced into the female genital tract through in vitro fertilization and today it is one of the most effective assisted reproduction procedures.

All tests and analyzes must be carried out by a specialist. Infertility can have multiple causes, so an accurate diagnosis is essential in order to plan personalized treatment. Contact us today to make an appointment!

 

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1.- Schedule your appointment

2.- Talk to our specialist

3.- Prepare your studies

4.- Attend your consultation

5.- Start your treatment plan

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